Presbyterian
Health Plan (PHP) in Albuquerque, New Mexico, is offering their physical and
occupational therapy providers an opportunity to transition from the standard
therapy authorization process to a process of collecting functional outcomes for
their members. PHP has selected
Focus On Therapeutic Outcomes, Inc. (FOTO®) as the functional outcomes provider
for this project.
FOTO®’s
PI® software classifies the patient at intake with proven risk-adjustment
criteria (impairment, severity, age, acuity, and surgical history) and predicts
the patient’s functional improvement and number of visits using similar
patients in FOTO®’s national database. The
average number of visits for similar patients in the database is reported and
will be automatically approved by PHP. If
additional visits are needed, the Provider can complete a Functional Health
Status survey with the PI® software to measure the patient’s progress as
compared to risk-adjusted national comparative data.
Kathy
Scott, PT, PHP Utilization Review Rehab Specialist, has championed this process
since its inception because it creates efficiencies both for the healthcare
provider and for Presbyterian Health Plan by dispensing with prior
authorizations. She says “The
transition of focus from limiting costs to measuring quality of care gives the
providers the opportunity to practice 'evidence-based' rehabilitation and to
direct and validate treatment plans for each individual member.
It also makes providers accountable for both cost and quality of care
they provide PHP members and improves the ability for care coordination for
members with complex medical needs, based on actual outcomes data.”
The
project is scheduled to begin by Summer 2005.